FOOD ADDICTION: A PARAMETER TO BE STUDIED BEFORE OBESITY SURGERY
Obesity is a real epidemic. It is the cause of many medical and social complications. Its management is complex and could be improved by better knowledge of its mechanisms, including food addiction.
Food addiction is a recent concept which links eating disorders (ED) and abnormal consumption of certain particular foods and in exaggerated quantities: sugar for example.
To make the difference between real behavioral problems and addiction to certain foods, there is the Yale Food Addiction Scale. It is a standardized questionnaire developed in 2009 by three doctors in clinical psychology. Indeed, even if food addiction is a much discussed and controversial concept, we feel, even on an individual level, that it is more difficult to resist a packet of crisps or a good chocolate cake than to a plate of rice and broccoli.
Food addiction: a significant proportion in obese people
33% of obese people eligible for bariatric surgery (and therefore not suffering from classic eating disorders) suffer from food addictions in a recent French study. Overall, among overweight or obese people, the percentage of these addictions would be 25%. They are mostly severe (57% of cases) and affect more women (37% against 17). The other socio-demographic factors did not seem to have a clear impact on the prevalence of these addictions. Likewise, the classic complications of obesity were not aggravated by these addictions.
Obesity, surgery and food addiction
When nothing is working, obese patients generally go to the last possible option: surgery. This choice often follows many failures and an exacerbated psychological suffering of the patients. This is the last chance card to regain some self-esteem. The intervention generally consists in reducing the size of the stomach (SLEEVE, or bypassing the upper part of the intestine where the absorption of nutrients is required, requiring a lifetime supplementation thereafter) so that the patient loses weight and feel less hungry.
On the other hand, the intervention in no way resolves the dietary and psychological problems of the patients. This is why prior monitoring, with a multidisciplinary team including dieticians and psychologists, is mandatory and the presence of TCA constitutes a temporary contraindication to an operation.
Bariatric surgery: the last chance
Having surgery to "cure" obesity is not trivial. As stated above, a multidisciplinary follow-up of at least six months is required between the request and the day of the operation. Rather, the real problem stems from the obesity journey as a whole, often too short and seen as a formality to be operated on by patients, not as a means of avoiding surgery thanks to the multidisciplinary help offered.
IN CONCLUSION
Obesity surgery remains the most effective way to "get out" of obesity.
The causes of obesity remain multiple: genetic, social, nutritional, psychological.
Screening for eating disorders and addictions is essential in order to be corrected, at least partially, before the intervention.
After the intervention, very long-term follow-up is essential to immediately correct a eating behavior disorder, the absence of "cropping" of which would lead to weight gain and an almost definitive failure of bariatric surgery.
The role of the nutritionist dietitian is therefore ESSENTIAL through his contact and advice.
Source: Futura Santé Scientific - August 2019